The nursing profession takes a certain dedication to love. After all, most office jobs don't involve standing for 12 hours at a time, scarfing a bite of lunch between "clients" or handling gallons of bodily fluids on a daily basis. But for years, nursing schools lured students with the promise that they would be snapped up by prestigious hospitals upon graduation, remunerated for their hard work with good pay and enviable job security.
And they were right - until now, that is.
It's a paradox straight out of "Freakonomics:" Even though California still faces a shortage of nurses, up to 40 percent of nursing school graduates will be unable to find jobs, according to the California Institute for Nursing and Health Care.
The recession set off a domino effect that has caused California hospitals to virtually stop hiring newly-minted nurses. The Institute estimates only half as many nurses will be hired this year as in 2008.
It's all thanks to Botox, healthcare reform and other people's husbands.

Back from retirement
Nine years ago, a severe nursing shortage was giving policy-makers night sweats. In 2001, national vacancies in nursing reached 13 percent, and over 120,000 nursing positions went unfilled, according to a report by the American Hospital Association. The numbers were especially dire in California, and in 2005 the state began funding and aggressively promoting nurse education.
"With this new initiative we are going to improve the quality of health care everywhere in our state. We are going to provide more classes, more teachers and more resources to expand the ranks of nurses in California," Governor Schwarzenegger said in a press release at the time.
It worked. California nursing schools saw enrollment rise by 70 percent over four years as the profession became increasingly touted as "recession-proof."
But the recession found a way.
A funny thing happened when the economy began to crumble. Peter Buerhaus, a nursing expert at Vanderbilt University, found that an astounding number of experienced nurses left their non-hospital jobs to work in hospitals.
Though only about 60 percent of nursing jobs are in hospitals, recent nursing graduates often rely on resource-rich hospitals to provide them with the extensive training they need to be considered ready to work with patients. In addition to having the best training opportunities, hospitals also happen to have the best pay, the best benefits and the best shifts.
"In two years, hospital employment grew by 243,000. That's a world record. That's astounding," he said. "People were coming in from all over. I mean, we've got nurses coming down from Uranus, from Pluto, waiting to get clearance to come down."
As one of the perks, many hospitals give nurses the option of changing a standard full-time schedule to three 12-hour shifts per week, which allows some nurses to pick up a second job on their free days.
It's a life-preserving strategy for when their spouses (70 percent of nurses have one) lose their jobs, as millions of Americans have since the recession hit.
Retired and part-time nurses all over the country have been returning to work full time when their spouses' jobs were threatened, or eliminated. Faced with the option of hiring an experienced nurse or a novice who needs training, the choice for hospitals is clear.
Or as a Marina Del Rey hospital representative said, "We are not hiring new grads at all. With the employment market the way it is right now, we don't have to."
And nurses who were going to retire decided to stay put.
"The turnover is almost nil," said UCLA nursing school Dean Suzette Cardin. "They're just not leaving. Everyone's afraid to leave."
These older, returning nurses have crowded out novice nurses who need training. And they've done so in greater numbers in California, where the economy has tanked harder and where there tends to be more workers nearing retirement age.
"There may have been a bigger reservoir of older nurses that weren't working in California," Buerhaus said, "and you had a very strong reaction of nurses getting back in the labor market."

Fewer implants, greater uncertainty
One of the first casualties of the recession was disposable income and all the luxury items - watches, cars, and errr...silicone - that it buys: Allergen saw sales of Botox and breast implants plummet in 2009.
And as job loss led to health insurance loss, people were re-thinking not just nose jobs, but knee surgeries.
The decline has led to less demand for nurse assistance during some procedures. "Elective surgeries are down, so patient days are down," said Deloras Jones of the California Institute for Nursing and Healthcare.
On top of that, hospitals are reluctant to beef up their staffs while the healthcare debate rages on. Hire too many nurses now, and in a few months they might be stuck paying more in salaries while getting reimbursed less by insurance companies.
"Hospitals are uncertain about what their near-term future is," Buerhaus said. "It's taxes one day, payment reductions the next. Given that uncertainty, it's slowing their employment decisions."

Pumping a dry well
Taken together, these factors have shattered the popular narrative of nursing jobs that are easy to come by. Cedars-Sinai hospital cut their job openings for new grads from 250 last year to 100 this year. UCLA's hospital typically has two new graduate intake sessions - one in the spring and one in the fall. This year, the spring session has been canceled.
"A lot of nurses have applied to the UCLA new grad program in August," said Kathy Carder of the California Nurses Association. "But in the meantime, they're wondering how they're going to feed their families."
It took Cedric Lara seven months and 40 applications to find a job after he graduated with an associate's degree in nursing from Whittier's Rio Hondo college in May 2009.
"When I was in school, I was looking at jobs and seeing the well dry up," Lara said. "Even hospitals where I looked during clinical rotation - Kaiser, Downey Regional, Presbyterian - by the time I graduated, they had hiring freezes."
In Northern California, the prospects are even worse. Jessica Martin graduated with a master's degree in nursing from the University of San Francisco in December, and she said just six of the 25 people in her cohort have gotten jobs so far. Those who have relied mainly on personal connections.
"It was pretty misleading," she said. "The people that graduated before me were getting jobs easily, and people were recruiting them. But then I graduated, and there's nothing."
Martin is hoping for an operating-room job, but so far the only hospitals admitting new grads are those like Stanford, where there are 600 applicants for three to six open positions.
"I'm sending my resume out into the ether, and nothing is coming of it," she said. "It's fairly hopeless right now."
For some, hope lies in less sought-after jobs outside of hospitals and doctors' offices.
"Before, a new grad had 20 offers, but this is forcing them to seek other opportunities than what they thought," said Kathy Lopez of the National Association of Hispanic Nurses. "Some students may have to start in a convalescent home, or maybe doing flu clinics."
Some, like Martin, are looking out of state. Her student loans are coming due, and the alternative is moving back in with her parents.
"I'm 28 years old and I might be financially dependent again," she said. "I'm trying not be be bitter and angry about it, it just takes time."
Ironically, California is still projected to have a nursing shortage in 2020, especially since the older nurses are likely to swiftly re-retire after the economy rebounds.
Until that time comes, however, a pool of cash-strapped nursing school grads wait with increasing frustration. Healthcare experts hope they don't give up before the recession does.
"We've been working hard to build our capacity, and we're worried that if new grads can't find jobs, we'll lose the gains we've made," Jones said. "Because if they leave California, they may not come back."

Sunday, February 21, 2010 |
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